Orgasmic migraine aura: Report of two cases

Cephalalgia ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 153-156 ◽  
Author(s):  
Heather Angus-Leppan ◽  
Alice Caulfield
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Sexual Activity ◽  
Case Reports ◽  
Primary Headache ◽  
Neurological Symptoms ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Migraine Aura ◽  
Cerebral Vasoconstriction ◽  
Underlying Causes

Background Paroxysmal neurological symptoms occurring with sex cause considerable anxiety and sometimes have a serious cause. Thunderclap headache is the most well-known and requires urgent investigation at first presentation for subarachnoid haemorrhage and other significant pathologies. After exclusion of underlying causes, many prove to be primary headache associated with sexual activity. Orgasmic migraine aura without headache is not currently recognised as a clinical entity. Case reports We report two patients with acephalgic orgasmic neurological symptoms fulfilling the criteria for migraine aura. Conclusions The incidence of acephalgic orgasmic migraine aura is unknown. It should be considered as part of the differential of paroxysmal sex-related neurological symptoms, and clinically differentiated from fixed deficits, reversible cerebral vasoconstriction syndrome and post-orgasmic illness syndrome.

Reversible cerebral vasoconstriction syndrome

2020 ◽  
pp. 447-456
Author(s):  
Aneesh B. Singhal
Keyword(s):  
Drug Use ◽  
Sexual Activity ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Over The Counter ◽  
Cerebral Vasoconstriction ◽  
Intracranial Arteries

Reversible cerebral vasoconstriction syndrome (RCVS) is a term used to describe a group of conditions characterized by reversible segmental narrowing and dilatation of multiple intracranial arteries. Most patients present with an explosive-onset, severe (thunderclap) headache. Thunderclap headaches frequently recur over days to weeks. Recent studies suggest that RCVS and primary thunderclap headache belong to the same spectrum of disorders, justifying the inclusion of RCVS in this textbook of headache syndromes. Up to one-third of patients do not have any identifiable trigger; however, most cases have been associated with exposure to vasoconstrictive medications, illicit drug use, over-the-counter agents, sexual activity, and childbirth.

Diagnosis and classification of headache associated with sexual activity using a composite algorithm: A cohort study

Cephalalgia ◽  
2021 ◽  
pp. 033310242110289
Author(s):  
Po-Tso Lin ◽  
Yen-Feng Wang ◽  
Jong-Ling Fuh ◽  
Jiing-Feng Lirng ◽  
Yu-Hsiang Ling ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Sexual Activity ◽  
Diagnostic Algorithm ◽  
Primary Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Artery Dissection ◽  
Vascular Disorders ◽  
Cerebral Vasoconstriction ◽  
Clinical Profiles ◽  
Secondary Causes

Background To differentiate primary headache associated with sexual activity from other devastating secondary causes. Methods In this prospective cohort, we recruited consecutive patients with at least 2 attacks of headache associated with sexual activity from the headache clinics or emergency department of a national medical center from 2005 to 2020. Detailed interview, neurological examination, and serial thorough neuroimaging including brain magnetic resonance imaging and magnetic resonance angiography scans were performed on registration and during follow-ups. Patients were categorized into four groups, i.e. primary headache associated with sexual activity, reversible cerebral vasoconstriction syndrome, probable reversible cerebral vasoconstriction syndrome, and other secondary headache associated with sexual activity through a composite clinic-radiological diagnostic algorithm. We compared the clinical profiles among these groups, including sex, age of onset, duration, quality, and clinical course (“chronic” indicates disease course ≥ 1 year). In addition, we also calculated the score of the reversible cerebral vasoconstriction syndrome2, a scale developed to differentiate reversible cerebral vasoconstriction syndrome from other intracranial vascular disorders. Results Overall, 245 patients with headache associated with sexual activity were enrolled. Our clinic-radiologic composite algorithm diagnosed and classified all patients into four groups, including 38 (15.5%) with primary headache associated with sexual activity, 174 (71.0%) with reversible cerebral vasoconstriction syndrome, 26 (10.6%) with probable reversible cerebral vasoconstriction syndrome, and 7 (2.9%) with other secondary causes (aneurysmal subarachnoid hemorrhage (n = 4), right internal carotid artery dissection (n = 1), Moyamoya disease (n = 1), and meningioma with hemorrhage (n = 1)). These four groups shared similar clinical profiles, except 26% of the patients with primary headache associated with sexual activity had a 3 times greater chance of running a chronic course (≥ 1 year) than patients with reversible cerebral vasoconstriction syndrome. Of note, the reversible cerebral vasoconstriction syndrome2 score could not differentiate reversible cerebral vasoconstriction syndrome from other groups. Conclusion Our composite clinic-radiological diagnostic algorithm successfully classified repeated headaches associated with sexual activity, which were predominantly secondary and related to vascular disorders, and predicted the prognosis. Primary headache associated with sexual activity and reversible cerebral vasoconstriction syndrome presented with repeated attacks of headache associated with sexual activity may be of the same disease spectrum.

scholarly journals Reversible cerebral vasoconstriction syndrome: the importance of follow-up imaging within 2 weeks

2020 ◽  
Author(s):  
Kiyomitsu Fukaguchi ◽  
Tadahiro Goto ◽  
Hiroyuki Fukui ◽  
Ichiro Sekine ◽  
Hiroshi Yamagami
Keyword(s):  
Differential Diagnosis ◽  
Treatment Strategies ◽  
Primary Headache ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
High Systolic Blood Pressure ◽  
Cerebral Vasoconstriction ◽  
Ct Findings ◽  
History Of

Abstract Background: In patients with thunderclap headache, reversible cerebral vasoconstriction syndrome (RCVS) should be considered as a differential diagnosis. However, RCVS diagnosis in the emergency department (ED) remains challenging. This study described the clinical features of RCVS, determined the factors related to RCVS diagnosis, and suggested treatment strategies for its management. Methods: We retrospectively identified eight patients diagnosed with RCVS and reviewed their medical records. From January 2010 to March 2019, eight patients with RCVS (ages 18-69 years, 5 females) were identified. Results: The median duration from the ED visit to RCVS diagnosis was 6 days (range, 1-11 days). Of the eight patients, seven were middle-aged, six had apparent triggers, six had subarachnoid haemorrhage (SAH), five had high systolic blood pressure, and none had any specific abnormality observed upon physical examination. At the ED visit, RCVS was diagnosed in only one patient with a history of RCVS. In other patients, SAH was diagnosed in two patients, and primary headache was diagnosed in four patients with negative computed tomography (CT) findings. Based on the follow-up imaging, seven of eight patients with convexal SAH were diagnosed as having RCVS (as the cause of SAH) using angiography (e.g., magnetic resonance angiography). Conclusions: RCVS with negative CT findings at the ED visit was likely to be misdiagnosed as primary headache. In patients with thunderclap headache and negative CT findings, physicians should consider RCVS as a differential diagnosis, inform patients of the risk of RCVS and the likelihood of a negative image evaluation early in the course of the disease, and carry out follow-up imaging within 2-weeks of the visit.

scholarly journals Primary headache associated with sexual activity

Pain medicine ◽  
2019 ◽  
Vol 4 (1/1) ◽  
pp. 15-16
Author(s):  
В В Білошицький
Keyword(s):  
Sexual Activity ◽  
Primary Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction

Пацієнт, 48 років, звернувся зі скаргами на приступи інтенсивного головного болю, що виникає під час оргазму. Уперше такий приступ виник за 13 днів до консультації під час статевого акту з новою партнеркою, який супроводжувався значним сексуальним збудженням. Напад повторився через 3 дні під час наступного статевого акту і ще за 6 днів після другого. Відчуття болю з’являється в лівій потиличній ділянці голови, інтенсивність зростає протягом 3 секунд, допоки не виникає надзвичайно сильний біль (VAS 8–9), який при розпитуванні пацієнт характеризує як найсильніший у житті («наче лусне голова»). Біль локалізується в лівій потилично-скроневій ділянці з відчуттям «тиску на очі». Інтенсивний біль тривав 1,5–2 хвилини, потім його вираженість зменшувалася до VAS 3, і такий остаточний біль зберігався до 1,5 години. На початку на-паду пацієнт приймав 2 таблетки спазмалгону (метамізол натрію моногідрат, пітофенону гідрохлорид, фенпіверинію бромід).Головний біль не супроводжується нудотою, фото- й фонофобією. Також немає вегетативних проявів, характерних для тригемінальних вегетативних цефалгій (ін’єкція кон’юнктиви та/або сльозотеча, закладення носа та/або ринорея, набряк повік, потіння лоба та обличчя, почервоніння лоба та обличчя, відчуття закладення вуха, міоз та/або птоз).Під час третього нападу пацієнт, відчувши «пульсацію в голові», зменшив активність і рівень збудження, внаслідок чого біль не сягнув вище рівня VAS 4 і згодом припинився. Пацієнт зазначає, що замолоду мав один епізод головного болю (не пов’язаного з сексуальною активністю), що тривав кілька днів. Із 35-річного віку з’явилися головні болі тієї ж локалізації (ліва потилично-скронева ділянка), тупі, низької інтенсивності (VAS 3), які виникають при фізичних навантаженнях, особливо пов’язаних із нахилами («качання черевного преса» – не більше 15 нахилів, робота на городі – сапання).При нападах інтенсивного головного болю, що настають вибухоподібно, у тому числі при першому нападі головного болю, пов’язаного з сексуальною активністю, завжди слід виключати такі види патології, як субарахноїдальний крововилив, внутрішньочерепна й екстракраніальна артеріальна дисекція та синдром оборотної мозкової вазоконстрикції – reversible cerebral vasoconstriction syndrome (RCVS). Ми призначили мультиспіральну комп’ютерну томографію (МСКТ) черепа й головного мозку з МСКТ-ангіографією, яка не виявила патологічних змін.

scholarly journals DIAGNOSTICS OF REVERSIBLE CEREBRAL VASOCONSTRICTION SYNDROME: CLINICAL MANIFESTATION AND IMAGING PATTERNS

2018 ◽  
pp. 50-55
Author(s):  
E. G. Klocheva ◽  
V. V. Goldobin
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Clinical Manifestation ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Treatment Modification ◽  
Cerebral Vasoconstriction

Data of 130 patients with thunderclap headache are presented. The data include clinical manifestation analysis and neuroimaging results (magnetic resonance angiography). Magnetic resonance angiography was performed 15 days after acute clinical manifestation and permitted to verify cerebral vasoconstriction, that led to treatment modification with clinical and neuroimaging signs of vasoconstriction reverse.

scholarly journals Long-Term Outcomes After Reversible Cerebral Vasoconstriction Syndrome

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 670-673 ◽  
Author(s):  
Rosalie Boitet ◽  
Solène de Gaalon ◽  
Claire Duflos ◽  
Grégory Marin ◽  
Jérôme Mawet ◽  
...  
Keyword(s):  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Long Term Outcomes ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Follow Up Study ◽  
Cerebral Vasoconstriction ◽  
History Of

Background and Purpose— We aimed to further investigate the long-term outcomes after reversible cerebral vasoconstriction syndrome (RCVS). Methods— A longitudinal follow-up study was conducted in 173 RCVS patients. Results— Of the 172 patients who completed a mean follow-up of 9.2±3.3 years, 10 had a recurrent RCVS that was benign in all. Independent predictors of relapse were having a history of migraine and having exercise as a trigger for thunderclap headache during initial RCVS. After new delivery, the rate of postpartum RCVS was 9%. Conclusions— Overall, long-term outcome after RCVS is excellent.

Thunderclap Headache

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Thunderclap Headache ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction ◽  
Vasoactive Medication ◽  
Angiographic Findings

Reversible cerebral vasoconstriction syndrome can cause thunderclap headache, subarachnoid hemorrhage, and stroke. The clinical presentation can be similar to aneurysmal subarachnoid hemorrhage and therefore requires rapid angiography. Angiographic findings of vasculopathy and resolution of clinical symptoms and imaging abnormalities support this diagnosis. This syndrome is most often incited following pregnancy or the ingestion of a vasoactive medication.

Neurologic Emergencies (DRAFT)

2018 ◽  
Author(s):  
Tamara Kaplan ◽  
Tracey Milligan
Keyword(s):  
Status Epilepticus ◽  
Intracranial Pressure ◽  
Subarachnoid Haemorrhage ◽  
Vascular Malformation ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Increased Intracranial Pressure ◽  
Cerebral Vasoconstriction ◽  
Neurologic Emergencies

The video in this chapter discusses neurologic emergencies, including the symptoms of increased intracranial pressure leading to herniation, subarachnoid haemorrhage (can be due to aneurysm, vascular malformation, or reversible cerebral vasoconstriction syndrome, and definition and management of status epilepticus.

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